NCC230640_FRO Submitted_20230310

FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name
US-1 NORTH COMMERCE CENTER
2
Location of land -disturbing activity: County FRANKLIN City or Township
LONG MILL ROAD 36.038162-785046 3
Highway/Street LatltUde(decimaldegrees) LOngitUde(decimaldegrees)
3.
Approximate date land -disturbing activity will commence. SPRING 2023
Purpose of development (residential, commercial, industrial, institutional, etc.): INDUSTRIAL
4.
5 Total acreage disturbed or uncovered (including off -site borrow and waste areas): 39
Amount of fee enclosed: $ 3,900 The application fee of $100.00 per acre (rounded
6' up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed 9 No ❑
8 Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name SCOTT M. REESE E-mail Address [e-mail]
Phone: Office # 314-584-6222
Mobile #
9 Landowner(s) of Record (attach accompanied page to list additional owners):
ARROWROCK IV LONG MILL, LLC
Name
135 N. MERAMEC AVE, STE #600
Current Mailing Address
ST LOUIS MO
City State
10.
Deed Book No. 1829
63105
Phone: Office #
Current Street Address
Zip City
Page No. 779
Mobile #
State
Zip
Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) if the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
ARROWROCK IV LONG MILL, LLC
Company Name
135 NORTH MERAMEC AVENUE, STE. #600
Current Mailing Address
ST. LOUIS MO 63105
City State Zip
Phone: Office #- 314-584-6222
[e-mail]
E-mail Address
Current Street Address
City
Mobile #
State
-r
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
CAPITOL CORPORATE SERVICES, INC. [e-mail]
Name of Registered Agent E-mail Address E-mail Address
176 MINE LAKE CT., SUITE #100
Current Mailing Address Current Street Address
RALEIGH NC 27615
City State Zip City State Zip
Phone: Office # 800) 316-6666 Mobile #
PAUL MORALES
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City
Phone: Office #
State
Zip City
Mobile #
Name of Individual to Contact (if Registered Agent is a company)
State Zip

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State
Phone: Office # Mobile #
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City
Phone: Office #
Company 4 Name
Current Mailing Address
City
Phone: Office #
Company 5 Name
Current Mailing Address
City
Phone: Office #
State Zip City
Mobile #
E-mail Address
Zip
State Zip
Current Street Address
State Zip City State
Mobile #
E-mail Address
Current Street Address
Zip
State Zip City State Zip
Mobile #

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Name Phone: Office # Mobile #
Current Mailing Address
City State
Deed Book No
Landowner 3 of Record-
Name
Current Mailing Address
City
Deed Book No
Landowner 4 of Record:
Name
Current Mailing Address
City
Deed Book No._
Landowner 5 of Record.
Current Street Address
Zip City State Zip
Page No. Provide a copy of the most current deed.
Phone: Office #
Current Street Address
State Zip City State Zip
Page No._ Provide a copy of the most current deed.
Phone: Office #
Current Street Address
State Zip City
_ _ Page No.
Name
Current Mailing Address
City State
Deed Book No.
Mobile #
Mobile #
State Zip
Provide a copy of the most current deed.
Phone: Office # Mobile #
Current Street Address
Zip City State Zip
Page No. Provide a copy of the most current deed.

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
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Signature Date
1, L I 1k irAr" S , a Notary Public of the County of e�krq YA
t SSi��,rj
State of ilrla, hereby certify that'? & 4 M . 9k-e- appeared personally
before me this day and being duly swom acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this day of DP Cep 2a
USAM. GATES
NOTARY PUBLIC - NOTARY SEAL
STATE OF MISSOURI
MYCOMMISSION E)"RES OCTOBER 31, 2024
JEFFERSON COUNTY
COMMISSION N1240M
Notary
My commission expires '�